People who have experienced sexual assault or trauma

Staff training

Encourage all healthcare providers to undertake training about sexual assault, supporting patients to participate in cervical screening, managing disclosure and making referrals to specially trained cervical screening providers. This training should build knowledge and skills to feel more confident to meet the needs of women.

Appropriate communication

• Present opportunities for disclosure of sexual assault (e.g. including questions during history taking).
• Offer more than one appointment and/or longer appointment times (e.g. the first visit to familiarise the patient with healthcare providers, procedure and instruments and the second for the test itself). This strategy will also help build rapport and trust.
• Provide clear information about the screening options available, including self-collection or clinician-collection.
• If clinician-collection is chosen the below points may be helpful:
  • Ask the patient for their consent before undertaking the test.
  • Acknowledge the difficulties that screening poses for these patients and your willingness to support them through the test.
• Provide patients with control over their appointment (e.g. they can ask to stop the test at any time.)
• Provide time to explain the test and allow women to ask any questions, including that they have the right to request a female provider.
• Reassure the patient that the consultation is private and confidential.

Make the procedure as comfortable as possible

• Offer self-collection as a more comfortable and acceptable screening option.
• Consider offering home-based self-collection (e.g. via a telehealth consultation) where appropriate.
• If clinician-collection is chosen some of the below points may assist.
  • Offer patients the opportunity to perform the test in a different position (e.g on their side rather than their back, letting them have their hands and arms free during the examination).
  • Consider use of a smaller speculum.
  • Some patients may prefer to insert their own speculum and it can be helpful to offer this option.
  • Providing instructions on calming and deep breathing techniques can also help the patient to relax.

Supportive environment

• Place relevant posters or pamphlets in your practice to indicate an awareness and willingness to discuss sexual assault and support patients to undertake cervical screening.
• Encourage the patient to bring a friend or support person to the appointment.
• Offer and/or advertise the availability of counsellors and provide contact details.

Patient records

If sexual assault is disclosed, flag this in medical records so healthcare providers are aware for future visits.

Choice of cervical screening collection method

• Offer the choice of either self-collection or clinician-collection screening options.
• Explain the pros and cons of each option, including follow-up requirements if HPV is detected on a self-collected vaginal sample.

Choice of cervical screening provider

• Ensure female cervical screening providers are available if requested.
• Refer patients to a cervical screening provider who is experienced in working with people who have experienced sexual assault.
• If sexual assault is disclosed, provide additional support and referrals as required.